Possible Syphilis Infection

Dec 17, 1997

Approximately nine years ago while stationed in South Africa, I had sex with a colored woman off of the street. About 3-4 weeks later, a small pimple appeared near the base and on the underside of my penis. Another smaller one appeared a few days later. Both pimples were gone after only a few days, maybe a week at most. About 2-3 months after the encounter, I had an outbreak of herpes zoster on my forehead above my left eye. I also remember feeling generally ill and run down for a while. I also had a decapacitating migraine headache one day, something I had never experienced before. About one year following the encounter, while stationed in West Africa, I remember having sores on the inside of my mouth, with skin peeling off (could have been side effect of anti-malarial medication?). To this day, I have some kind of rash (very small bumps) on the head of my penis (warts?). I also have a strange rash on my upper lip -- small white bumps -- that I had never noticed until after that encounter, although it may have been there beforehand.

It wasn't until very recently that I realize I may have had syphilis. I have recently tested negative with VDRL and FTA, but am wondering how accurate these tests are after nine years of infection. I know that RPR can return to normal, but what about FTA? I had malaria in West Africa -- could this or the treatment I received have an adverse effect on the test results? And if it wasn't syphilis, what was it? I have also tested HIV- for the past several years (every 6 mos.). Is it possible to have a negative FTA and have CNS syphilis? Are there any other tests I should run through?

Thanks for the assistance.

Response from Mr. Sowadsky

Hi. Thank you for your question.

As I am sure you are aware, nobody can diagnose any of your symptoms over the computer or over the phone. The ONLY way to know what is causing any symptoms you are having is to see a doctor, and have lab tests performed. The symptoms you are describing are not consistent to those of syphilis. See the posting, "Syphilis" which goes into detail about the symptoms of syphilis. Please do not convince yourself you have syphilis (or anything else for that matter), based on symptoms. This is very important.

Testing for syphilis can be extremely confusing to understand, since interpretation of tests can be quite complicated. There are different types of syphilis tests. Blood tests for syphilis (described below) will most often show positive by the secondary stage. The following are GENERAL guidelines that doctors follow regarding syphilis testing. Prepare to be confused.

The first tests that are done are either the VDRL, or the RPR (most often, these are blood tests). A high titer of either of these tests indicate a recent infection. However, because various things can affect these tests, they should always be confirmed with a confirmatory test. These confirmatory tests are either the MHA or the FTA. If a person has a reactive VDRL or RPR, and a reactive MHA or FTA, and they have never had syphilis before, this indicates a new infection. After treatment, the VDRL or RPR will usually (but not always) go to low levels, or may revert back to a negative result. The MHA or FTA will usually remain positive for the rest of the persons life.

Syphilis is a curable disease, but if a person is re-exposed, they can be infected again, and they would need to be re-treated. Because the MHA and FTA tests remain positive for life, these tests cannot be used to determine re-infection with Syphilis. The only way to determine if a person is re-infected using these tests, is to look for increasing values on subsequent VDRL tests or RPR tests. If the titers of the VDRL or the RPR increase, this indicates re-infection, and re-treatment is necessary.

Confused? You should be. This is because interpretation of syphilis tests can be very confusing. If the person is also HIV positive, interpretation of these tests can change. Doctors very often have to contact STD specialists to correctly interpret these tests (especially if the person is HIV positive). Since you have tested negative on the FTA, this indicates you were not infected with syphilis (unless you were very recently infected). Please see your doctor regarding any symptoms you may be having.

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).

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